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The doctor visit for hay fever


By Louis Neipris, MD
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Here you go again! It hits you during a walk beside a blooming garden or as you descend the stairs to the damp basement. You start to sneeze. And it’s not just one sneeze, or even two: it’s a sneezing attack. You may also have a runny, stuffy nose and itchy watery eyes. Connecting all the dots, you conclude you have hay fever.

If you are like many of the 12 million Americans who see their doctor for hay fever, a condition called allergic rhinitis, it isn’t just about symptoms. It’s about the quality of life. Allergies can get in the way of work, school and play.

Could I just have a bad cold?
It’s easy to confuse hay fever with the common cold. Along with nasal congestion, both conditions can cause sneezing and sinus pressure. But unlike the common cold, allergic rhinitis tends to hang around, for a season or all year round. The symptoms of hay fever may also come on after exposure to a trigger.

What does it mean to be “allergic?”
Hay fever is an allergic reaction to an airborne allergen. An allergen is a substance that most people find harmless. But an allergic person who is exposed to an environmental allergen (pollen or mold) makes antibodies, called IgE. The IgE binds to the allergen, then attaches to mast cells that release histamine. Histamine is a chemical that causes the irritating symptoms of allergies.

Why should I see my doctor for allergies?
Your doctor can help with your symptoms and improve the quality of life. Untreated, allergies can also lead to infection of the sinuses (called sinusitis) and nasal polyps.

Allergies are commonly associated with:

  • Asthma. For some, allergy triggers may also be asthma triggers. Airways constrict and become inflamed in response to the same things in the environment that make you sneeze.
  • Eczema. Dry, itchy skin and rash are common in people with seasonal allergies (hay fever) as well as indoor allergies. Untreated eczema can be irritating and lead to itching and possibly a skin infection.

Your doctor visit for allergies
Your doctor will ask you questions about your symptoms, when they began and whether you have them indoors, outdoors or both. Tell your doctor about your family history of allergies and if you have hives, eczema and asthma. Also:

  • List symptoms, new and old. Often people have different symptoms from year to year. Describe not only your current symptoms, but also compare this year’s symptoms with last year’s. Tell if you have any cough, shortness of breath or wheezing, as these could be symptoms of asthma.
  • Tell how your symptoms interfere with your life. Do symptoms leave you sleepless or cause missed work? Are you afraid to go outside in the springtime?
  • Mention medications you take for symptoms. List over-the-counter medications and any herbal supplements as well as prescription drugs.

When is referral to an allergist-immunologist necessary?
Your primary care doctor (internist or family doctor) may be able to take care of your allergies. In some cases, though, you may need a referral to an allergist-immunologist. Some reasons for seeing an allergist-immunologist for hay fever include:

  • You still have symptoms even with medications prescribed by your primary care doctor
  • You have asthma as well as hay fever
  • You have recurrent sinusitis
  • Your symptoms interfere with the quality of life
  • You have nasal polyps, benign growths in the nose

Allergy testing by a specialist
The most common diagnostic tests are the skin prick test and an allergy blood test.

  • Skin prick test. A small puncture is made into the skin under a drop of allergen extract. If you are allergic, exposure to the allergen triggers an allergic reaction within about 15 minutes. This is often a dime-sized hive. Your doctor records what allergens led to the reaction and the strength of your allergic reaction. The hives usually go away within about 30 minutes. He or she uses this information to advise you of your allergy triggers and create a treatment plan.
  • Allergy blood test. This test is sometimes called a “RAST” (radioallergosorbent) test. It looks for IgE antibodies in the blood. The antibodies are exposed to antigens in the laboratory. IgE antibodies that bind to the antigens are involved in an allergic reaction. This test can be used for people with skin rashes or who are on certain medications that would interfere with the skin prick test.

Will I be tested for asthma?
If you have wheezing or shortness of breath as well as allergy symptoms, your doctor may do a test called a “peak flow.” For this test, you breath into a tube as hard as you can. If the lung function is low due to constricted airways, your doctor may do further lung function testing.

Allergy treatment plan
Your doctor will use the information from the history, physical exam and allergy tests to come up with a treatment plan to treat your symptoms and help you avoid allergy triggers.

SOURCES:

  • American Academy of Allergy Asthma and Immunology. Tips to remember: asthma and allergy medications. Accessed: 10/29/2010
  • Schatz M, Leung D, Goldstein S. Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help. Journal of Allergy and Clinical Immunology. 2006;117(2 Suppl 3):S495-S523. Accessed: 03/24/2009
  • American Academy of Allergy Asthma & Immunology. AAAAI Work Group report: allergy diagnosis in clinical practice. Accessed: 03/24/2009
  • American Academy of Allergy Asthma & Immunology. Making the most of your spring allergy visit. Accessed: 03/24/2009
  • Asthma and Allergy Foundation of America. Allergy overview. Accessed: 03/24/2009

View the original The doctor visit for hay fever article on myOptumHealth.com


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